Nursing Elites

1. A nurse is caring for a client prescribed methotrexate for rheumatoid arthritis. Which of the following client history findings requires the nurse to question the administration of this medication?

• A. Osteoporosis
• B. Hypertension
• C. Peptic ulcer disease
• D. Immunosuppression

Correct answer: C

Rationale: The correct answer is C: Peptic ulcer disease. Methotrexate can exacerbate peptic ulcer disease, leading to serious complications. This finding warrants questioning the administration of methotrexate to prevent harm to the client. Choices A, B, and D are not directly contraindicated with methotrexate use. Osteoporosis, hypertension, and immunosuppression are not typically reasons to question the administration of methotrexate for rheumatoid arthritis.

2. A client has been prescribed lisinopril. Which of the following medication interactions should the nurse instruct this client about?

• A. Potassium supplements
• B. Ciprofloxacin
• C. Escitalopram
• D. Magnesium supplements

Correct answer: A

Rationale: The correct answer is A: Potassium supplements. Clients taking lisinopril should avoid potassium supplements and potassium-sparing diuretics due to the risk of hyperkalemia. This interaction can lead to dangerously high levels of potassium in the blood, which can be harmful. Choice B, Ciprofloxacin, is not typically associated with a significant interaction with lisinopril. Choice C, Escitalopram, is an antidepressant and does not have a known significant interaction with lisinopril regarding potassium levels. Choice D, Magnesium supplements, are generally safe to take with lisinopril and do not pose a significant risk of hyperkalemia.

3. A nurse is reviewing the medical record of a client who is prescribed acetaminophen for pain. Which of the following lab values should the nurse monitor to identify an adverse effect of the medication?

• A. Serum glucose
• B. Serum creatinine
• C. Serum potassium
• D. Serum bilirubin

Correct answer: B

Rationale: The correct answer is B: Serum creatinine. Acetaminophen is metabolized by the liver, so serum creatinine levels should be monitored for potential hepatotoxicity. Monitoring serum creatinine can help detect liver damage, a potential adverse effect of acetaminophen. Choices A, C, and D are incorrect because serum glucose is not directly affected by acetaminophen, serum potassium is not typically monitored for acetaminophen adverse effects, and serum bilirubin is more related to bile metabolism rather than acetaminophen-induced hepatotoxicity.

4. A nurse is preparing to administer furosemide to a client. Which of the following findings indicates the client may be at risk for an adverse effect of the medication?

• A. Hypertension
• B. Hypokalemia
• C. Increased urine output
• D. Hyperglycemia

Correct answer: B

Rationale: The correct answer is B: Hypokalemia. Furosemide is a loop diuretic that can cause potassium depletion, leading to hypokalemia, which is a common adverse effect. Hypokalemia can result in serious complications like cardiac arrhythmias. Choices A, C, and D are not directly associated with the adverse effects of furosemide. Hypertension is a condition that furosemide is often used to treat, increased urine output is an expected effect of furosemide, and hyperglycemia is not a typical adverse effect of this medication.

5. A nurse is caring for a client who is prescribed warfarin. Which of the following laboratory tests should the nurse review to evaluate the therapeutic effect of this medication?

• A. aPTT
• B. INR
• C. Serum glucose
• D. Bilirubin

Correct answer: B

Rationale: The correct answer is B: INR. The International Normalized Ratio (INR) is the most reliable test for evaluating the therapeutic effects of warfarin therapy. INR measures the clotting ability of the blood and helps determine if the dosage of warfarin is within the therapeutic range. Choice A, aPTT, is not typically used to monitor the effects of warfarin. Choice C, Serum glucose, and choice D, Bilirubin, are not relevant to monitoring the therapeutic effect of warfarin.

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